CC July 2017 Prevention of stroke after TIA

Section

Stroke is the ____leading cause of death in the US and a leading cause of long-term disability?

5th

How many adults in the US suffer an ischemic stroke every year?

700,000

List the risk factors for stroke?

1) DM 2) smoking 3) HTN 4) atrial fibrillation 5) hyperlipidemia

In patients who have experienced a non-debilitating stroke or TIA, the incidence of subsequent stroke is increased, especially within the first few _______ and ______ after the initial event even if contributing medical conditions are well managed?

days; weeks

This is particularly true in patients with significant carotid artery disease, defined as what?

*** Patients who have occlusion > 70%in the carotid artery should be considered for interventional therapy within the first ____ weeks following the neurological event when the risk of a second stroke is at its highest?

2

*** For patients < 70 y.o. who have suffered a TIA or no debilitating stroke, what procedure is considered an appropriate alternative to carotid endarterectomy, all long as the patient is medically stable and is treated in a center where carotid stenting has a procedural stroke rate and mortality rate < 6%?

carotid artery stent

What is the intervention of choice in medically stable patients > 70 y.o. Who are considered at low surgical risk?

CEA (carotid endarterectomy)

CEA and CAS should be performed at centers with an intaoperative stroke rate and morality rate of < ___%?

6

Patients who are > 70 y.o. Who are not good surgical candidates or who have radiation-associated stenosis, restenosis after previous CEA or inoperable carotid lesions (below the clavicle or above C2 vertebrae) may be considered for ______preferably within ____ weeks of the neurological event?

carotid artery stent; two

*** For patients more than 2 weeks out from the sentinel neurological event, CEA or CAS may help prevent recurrent stroke if performed within ____ months after the event?

6

CEA and CAS may be considered in patients with a TIA or non-debilitating stroke if carotid stenosis is ___ to ___% but must be evaluated on a case to case basis?

50-69%

CEA and CAS are currently being evaluated in the prevention of stroke in patients with asymptomatic carotid stenosis, although the risk of stroke in these patients is _____ and interventional risks of stroke and mortality may be _______ than the risk of stroke in some cases?

low; higher

In all cases of carotid artery stenosis, patients should receive medical therapy consisting of what?